Does Q82.0 require prior authorization?

No, Q82.0 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`Q82.0`, Hereditary lymphedema

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

The final report must include an impression or summary statement, a specific or differential diagnosis if appropriate, and recommendations for follow-up when clinically applicable.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Key Coverage Criteria

Doppler ultrasound (peripheral venous ultrasound) is the standard preoperative test to evaluate venous reflux in patients with chronic venous insufficiency.
CPT 93971 should be used to report either a limited bilateral duplex scan or a complete unilateral duplex scan for peripheral venous reflux evaluation.
Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.
Electrical stimulation (attended CPT 97032 or unattended HCPCS G0283) may be covered as part of a therapy plan of care to improve function when the nerve supply to the muscle is intact and atrophy is due to non-neurological disuse (e.g., post-casting, splinting, soft-tissue scarring).
Wheelchair management training (CPT 97542) is covered for patient and/or caregiver training in transfers and propulsion when documentation ties the training to attainable functional goals.

20 Active Policies

FIRST_COAST-L33693, Peripheral Venous Ultrasound

A57125, Billing and Coding: Peripheral Venous Ultrasound

NOVITAS-JH-L35451, Peripheral Venous Ultrasound

NOVITAS-JH-L35138, Routine Foot Care

A52996

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Q82.0, Hereditary lymphedema